摘要
目的探讨急性呼吸窘迫综合征(ARDS)患者的血清PCT及凝血指标对预后判断的价值.方法选取2016年1月至2019年12月在常州市武进中医医院重症医学科(ICU)住院治疗的ARDS患者共60例为研究对象进行回顾性临床研究,其中男性34例,女性26例;年龄34~75岁,平均(55.8±11.2)岁.按入院30 d时患者的生存情况,将研究对象分为生存组(36例)和死亡组(24例).收集两组患者一般资料、急性生理和慢性健康评分(APACHEⅡ)和肺损伤评分(Murray评分).比较两组患者于确诊ARDS后24 h内采集静脉血,检测血清降钙素原水平(PCT)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原(FIB)、D-二聚体(DD)指标的水平.利用Pearson相关性分析血清学检测结果与临床评分之间的关联性.绘制受试者工作特征曲线(ROC),评价相应指标对ARDS患者存活的预测能力.结果两组患者的APACHEⅡ评分[死亡组的(26.8±3.1)分比生存组的(22.3±2.6)分]与Murray评分[死亡组的(2.9±0.5)分比生存组的(2.2±0.3)分],死亡组均高于生存组(P均<0.05),血清PCT[(11.29±3.48)μg/L比(4.37±1.65)μg/L]、PT[(25.8±4.7±3.48)s比(16.4±3.1)s]、APTT[(49.4±5.1)s比(32.9±2.5)s]、DD[(4.92±1.05)s比(3.52±0.74)s]水平也高于生存组,但FIB水平低于生存组[(2.78±0.63)g/L比(4.26±0.91)g/L,P<0.05],而两组TT水平的差异无统计学意义(P>0.05).ARDS患者的血清PCT、PT、APTT、DD与APACHEⅡ和Murray评分均呈正相关(P均<0.05),FIB与临床评分均呈负相关(P均<0.05).PCT联合PT、APTT、FIB、DD的预测患者预后的AUC是0.963,显著高于各单一指标的预测价值.结论血清PCT以及PT、APTT、FIB、DD凝血指标与ARDS患者的肺损伤程度密切相关,且PCT联合凝血指标对ARDS患者的病情及预后判断有指导意义.
Objective To investigate the prognostic value of serum procalcitonin(PCT)and coagulation parameters in patients with acute respiratory distress syndrome(ARDS).Methods From January 2016 to December 2019,60 ARDS patients in Intensive Care Unit(ICU)of Changzhou Wujin Hospital of Traditional Chinese Medicine were selected for a retrospective clinical study.There were 34 males and 26 females,ranging in age from 34 to 75 years,with an average age of(55.8±11.2)years.According to the survival of patients at 30 days after admission,the subjects were divided into survival group(36 cases)and death group(24 cases).General data were collected and acute physiology and chronic health score(APACHE II)and lung injury score(Murray)were assessed.Venous blood was collected within 24 hours after the diagnosis of ARDS.Serum PCT level,prothrombin time(PT),activated partial thromboplastin time(APTT),thrombin time(TT),fibrinogen(FIB)and D dimer(DD)were measured.Pearson correlation was used to analyze the correlation between serological test results and clinical scores.The working characteristic curve(ROC)of subjects was drawn to evaluate the predictive ability of the corresponding indicators for the survival of ARDS patients.Results ApacheⅡscore[(26.8±3.1)in death group vs(22.3±2.6)score in survival group]and Murray score[(2.9±0.5)in death group vs(2.2±0.3)in survival group]in death group were higher than those in survival group(P<0.05),serum PCT[(11.29±3.48)μg/L vs(4.37±1.65)μg/L],Pt[(25.8±4.7±3.48)s vs.(16.4±3.1)s],APTT[(49.4±5.1)s vs.(32.9±2.5)s]and DD[(4.92±1.05)s vs.(3.52±0.74)s]in survival group were also higher than those in survival group,but FIB level in survival group was lower than that in survival group[(2.78±0.63)g/L vs.(4.26±0.91)g/L,P<0.05],but there was no significant difference in TT level between the two groups(P>0.05).Serum PCT,Pt,APTT and DD were positively correlated with ApacheⅡand Murray scores(P<0.05),while FIB was negatively correlated with clinical scores(P<0.05).The AUC of PCT combined with Pt,APTT,FIB and DD was 0.963,which was significantly higher than that of single index.Conclusion Serum PCT,PT,APTT,FIB and DD are closely related to the severity of lung injury in patients with ARDS,and PCT combined with coagulation indicators are of guiding significance in judging the condition and prognosis of patients with ARDS.
作者
李洪
蒋红英
庄乐
周丹
陆岑琳
Li Hong;Jiang Hongying;Zhuang Le;Zhou Dan;Lu Chenlin(Department of ICU,Changzhou Wujin Hospital of traditional Chinese medicine,Changzhou,Jiangsu 213161,China)
出处
《中华卫生应急电子杂志》
2020年第5期266-270,共5页
Chinese Journal of Hygiene Rescue(Electronic Edition)
基金
常州市2017年度社会发展科技支撑项目(CE20173061号)
江苏省卫生厅重大课题项目(Z201013)。
关键词
降钙素原
急性呼吸窘迫综合征
凝血指标
曲线下面积
Procalcitonin
Acute Respiratory Distress Syndrome
Coagulation Index
Area under Curve
作者简介
通信作者:李洪,Email:lihongdoctor@163.com。
